Navigating vaccination choices: The intersecting dynamics of institutional trust, belonging and message perception among Congolese migrants in the UK (A reflexive thematic analysis)

Background The COVID-19 pandemic has disproportionately impacted intersectionally marginalised migrants, revealing systemic disparities in health outcomes and vaccine uptake. An in-depth understanding of the underlying social and structural factors influencing health behaviours is necessary to develop tailored interventions for migrants but has been seldom explored. Therefore, this qualitative study aimed to explore the contextual factors shaping COVID-19 vaccination decision-making among Congolese migrants in the UK. Methods A community-based participatory research study was designed and led by a community-academic partnership in London, UK (2021–2022). Peer-led, semi-structured interviews were conducted in Lingala with 32 adult Congolese migrants and explored beliefs, perceptions and lived experiences of migration, healthcare and vaccination and the pandemic. Reflexive thematic analysis generated two themes and a model conceptualising the vaccination decision-making process was developed. Participants and community partners were financially compensated, and the study received ethical approval from the University of London ethics committee (REC: 2021.0128). Findings Participants highlighted the incompatibility of lockdown restrictions with their communal culture, which intensified feelings of exclusion and alienation. Concerns about COVID-19 vaccination were attributed to safety and effectiveness, partly informed by experiences and legacies of discrimination and exploitation of Black Africans. Inequality in the pandemic response and COVID-19 outcomes heightened participants’ sense that their views and needs were being overlooked and government sources and information were perceived as coercive. Drawing on this data, our model depicts the interplay between institutional trust, belonging, and message perception which shaped participants’ vaccination decisions and led to (non-)engagement with COVID-19 vaccination. Conclusion This research enhances understanding of how social and contextual factors may influence migrants’ engagement with health interventions. It underscores the necessity of partnering with migrant communities to understand their needs in context and co-design tailored interventions and inclusive messaging strategies which foster trust and belonging. Implementing systemic changes to address structural inequalities will be crucial to create an environment that supports engagement with health-protective behaviours and enhances health outcomes among migrant communities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Institute for Health Research (NIHR Advanced Fellowship 300072) and seed funding from St George’s Public Engagement Network. SH and AFC are additionally funded by the Academy of Medical Sciences (SBF005\1111) and the World Health Organization. SH acknowledges funding from the Novo Nordisk Foundation/La Caixa Foundation (Mobility– Global Medicine and Health Research grant). AD is funded by the MRC (MR/N013638/1). The funders did not have any direct role in the writing or decision to submit this manuscript for publication. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study received ethical approval from the University of London ethics committee (REC: 2021.0128). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data are available on reasonable request from the study authors.